Volume 98  ·  Issue 19  ·  2018

In recent years, meta-evidence from people with genetic risk and elderly people with normal clinical cognition has shown that the occurrence of Alzheimer's disease (AD) is a continuous pathological process that began years before the clinical diagnosis of dementia^[1]。 Due to the repeated failure of clinical trials of new drugs for the dementia stage of AD, researchers have gradually realized that the focus of AD research should shift to the pre-dementia stage of AD.

Dementia has become one of the leading diseases causing death and disability in the elderly, and Alzheimer's disease (AD) is the leading cause of dementia. According to the China Cognition and Aging Study (COAST Study), as of 2009, there were 9.2 million dementia patients in China, of which 62.5% were caused by AD^[1]。 The disability rate of AD is high, patients lose the ability to live independently in the late stage, and need to be taken care of by others completely, which brings a heavy economic burden and nursing burden to society and family. At present, AD still lacks drugs that can change the course of the disease, and symptomatic treatment is still the main treatment. Therefore, clarifying the risk factors of AD and carrying out early intervention and prevention against these risk factors is one of the feasible methods to reduce or delay the onset of AD.

To quantify emphysema and air trapping at inspiratory and expiratory phase multi-slice spiral CT(MSCT) scanning in smokers without respiratory symptoms, and analyze the correlation between the CT quantifiable parameters and lung function parameters.

A total of 72 smokers, who underwent medical examinations from September 2013 to September 2016 in Changzheng Hospital were enrolled in this research and were divided into two groups: 24 smokers with COPD and 48 smokers without COPD.Besides, thirty-nine non-smokers with normal pulmonary function were enrolled as the controls.All subjects underwent double phase MSCT scanning and pulmonary function tests.CT quantifiable parameters of emphysema included the low attenuation area below a threshold of -950 Hounsfield Units (HU)(LAA%_-950), the lowest 15th percentile of the histogram of end-inspiratory attenuation values (P_15-IN), the lowest 15th percentile of the histogram of end-expiratory attenuation values (P_15-EX), relative volume change(RVC) and the expiratory to inspiratory ratio of mean lung density (E/I_MLD). Pulmonary function parameters included forced expiratory volume in 1 second expressed as percent predicted (FEV₁%), forced expiratory volume in one second to forced vital capacity ratio (FEV₁/FVC), residual volume to total lung capacity ratio (RV/TLC) and carbon monoxide diffusion capacity corrected for alveolar volume (DLCO/VA). The differences of CT quantifiable parameters and pulmonary function parameters among the three groups were analyzed by using one-way analysis of variance or Kruskal-Wallis H test.The correlation between CT quantifiable parameters and pulmonary function parameters was analyzed by using Spearman′s correlation analysis.

The differences of LAA%_-950(the values for the controls, the group of smokers with out COPD and the group of smokers with COPD were 0.5%±0.7%, 0.7%±1.2% and 2.0%±2.4% respectively), P_15-IN(the values of the three groups were (-892±33), (-905±15) and (-907±22) HU respectively), FEV₁%(the values of the three groups were 88.4%±8.8%, 84.2%±7.5% and 82.1%±8.0% respectively), FEV₁/FVC(the values of the three groups were 78.0%±3.8%, 76.6%±4.3% and 67.3%±5.5% respectively), DLCO/VA (the values of the three groups were (1.36±0.25), (1.30±0.22) and (1.21±0.22) mmol·min^-1·kPa^-1·L^-1 respectively) and RV/TLC (the values of the three groups were 49.5%±6.6%, 45.9%±6.0% and 53.0%±6.4% respectively) among the three groups were statistically significant (all P<0.05). In the control group, LAA%_-950 negatively correlated with FEV₁/FVC and DLCO/VA(r=-0.32, P=0.04; r=-0.69, P=0.00) and neither did P_15-IN with FEV₁%(r=-0.14, P=0.02). Inversely, P_15-IN positively correlated with DLCO/VA (r=0.55, P=0.00). In the group of smokers without COPD, LAA%_-950 negatively correlated with FEV₁/FVC and DLCO/VA(r=-0.31, P=0.04; r=-0.42, P=0.00), and P_15-IN positively correlated with FEV₁/FVC and DLCO/VA (r=0.33, P=0.02; r=0.30, P=0.04). In the group of smokers with COPD, LAA%_-950 negatively correlated with DLCO/VA (r=-0.62, P=0.00), but positively correlated with RV/TLC (r=0.59, P=0.00). And P_15-IN positively correlated with DLCO/VA(r=0.53, P=0.01).

Smokers emphysema and air trapping can be effectively evaluated by double phase MSCT. Moreover, two of the CT quantifiable parameters, LAA%_-950 and P_15-IN, are highly sensitive to changes in pulmonary function.

To evaluate the effectiveness of Scoliosis Research Society (SRS)-Schwab grade Ⅳ osteotomy in the treatment of post-traumatic thoracolumbar kyphosis (PTK).

From October 2012 to January 2015, a total of 31 patients [12 males, 19 females, mean age (43±10) years] with symptomatic PTK undergoing SRS-Schwab grade Ⅳ osteotomy in Nanjing Drum Tower Hospital were retrospectively reviewed.Radiographic changes were evaluated with preoperative, postoperative and follow-up X-ray.The measurements included thoracic kyphosis (TK), lumbar lordosis (LL), thoracolumbar kyphosis (TLK), focal kyphosis (FK), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and sagittal vertical axis (SVA). Clinical outcome was assessed using the visual analogue scale (VAS), the Oswestry disability index (ODI) and Frankel neurological grade before surgery and during follow-up.The preoperative, postoperative and follow-up data were compared with paired t test.

All patients were followed-up for 28±5 months (24-38 months). The TK and LL improved significantly postoperatively from 15.6°±7.8° and 67.3°±12.2° to 28.1°±6.2° and 48.1°±9.3°(t=-6.985, 6.968, both P<0.05), and maintained at 27.3°±6.9° and 49.4°±7.9° at last follow-up, respectively.The TLK and FK improved significantly postoperatively from 29.4°±12.2° and 36.4°±9.5° to 7.7°±5.3° and 5.6°±4.2°(t=9.083, 16.510, both P<0.05), with a correction loss of 2.4°±2.0° and 2.3°±2.2° at final follow-up, respectively.No significant difference was observed in the PI, PT, SS and SVA among preoperative, post-operative and the last follow-up data.In addition, the VAS and ODI improved significantly at the final follow-up.Four cases with Frankel D experienced complete neurological recovery at the final follow-up.Radiographic evaluation showed solid bony fusion.No instrument-related complication was observed during the follow up.

The SRS-Schwab grade Ⅳ osteotomy brings satisfactory sagittal alignment and good clinical outcomes in patients with PTK.

To investigate the reliability of the distance between the tip of the greater trochanter and inter-teardrop line (GT-IT) in evaluating the leg length discrepancy (LLD) in patients underwent total hip arthroplasty (THA).

Patients who underwent THA in Xi′an Honghui Hospital from August 2015 to February 2016 were enrolled in this study.The patients were measured for bilateral hips anterior-posterior (AP) radiograph preoperatively and postoperatively.Four distances measured, included: GT-IT, the tip of lesser trochanter and bi-ischial line (LT-BI); LT-IT and the anterior superior iliac spine and the medial malleolus (ASIS-MM). Magnification factor was considered when calculating absolute values.Intraclass correlation coefficient (ICC) was used to detect the reliability of the measurement data.Single factor analysis and paired t test were performed to compare data among the methods.

The ICC values of the four groups were greater than 0.80, which showed excellent agreement in the measurements.Single factor analysis of variance showed there were no statistically significant differences in the LLDs of the four groups preoperatively and postoperatively (F=0.914, 0.886, both P>0.05). There was no significant differences in preoperative and postoperative LLD between group GT-IT and group ASIS-MM, LT-BI or LT-IT(t=-1.544-1.114, all P>0.05). The LLDs were comparable between group LT-BI, ASIS-MM and LT-IT both preoperatively and postoperatively (t=1.577, 0.976, 1.344, -0.087, all P>0.05). And the LLD in group LT-IT and ASIS-MM were equivalent preoperatively and postoperatively (t=0.130, 1.063, both P>0.05). Bland-Altman plot illustrated high level of agreements between the four methods.

Great reliability can be obtained with the GT-IT in evaluating the LLD in patients undergoing THA.

To explored the clinical application of the three-dimensional finite element model of atlantoaxial complex fracture.

A three-dimensional finite element model of cervical spine (FEM/intact) was established by software of Abaqus6.12.On the basis of this model, a three-dimensional finite element model of four types of atlantoaxial complex fracture was established: C₁ fracture (Jefferson)+ C₂ fracture (type Ⅱfracture), Jefferson+ C₂ fracture(type Ⅲfracture), Jefferson+ C₂ fracture(Hangman), Jefferson+ stable C₂ fracture (FEM/fracture). The range of motion under flexion, extension, lateral bending and axial rotation were measured and compared with the model of cervical spine.

The three-dimensional finite element model of four types of atlantoaxial complex fracture had the same similarity and profile.The range of motion (ROM) of different segments had different changes.Compared with those in the normal model, the ROM of C_0/1 and C_1/2 in C₁ combined Ⅱ odontoid fracture model in flexion/extension, lateral bending and rotation increased by 57.45%, 29.34%, 48.09% and 95.49%, 88.52%, 36.71%, respectively.The ROM of C_0/1 and C_1/2 in C₁ combined Ⅲodontoid fracture model in flexion/extension, lateral bending and rotation increased by 47.01%, 27.30%, 45.31% and 90.38%, 27.30%, 30.0%.The ROM of C_0/1 and C_1/2 in C₁ combined Hangman fracture model in flexion/extension, lateral bending and rotation increased by 32.68%, 79.34%, 77.62% and 60.53%, 81.20%, 21.48%, respectively.The ROM of C_0/1 and C_1/2 in C₁ combined axis fracture model in flexion/extension, lateral bending and rotation increased by 15.00%, 29.30%, 8.47% and 37.87%, 75.57%, 8.30%, respectively.

The three-dimensional finite element model can be used to simulate the biomechanics of atlantoaxial complex fracture.The ROM of atlantoaxial complex fracture is larger than nomal model, which indicates that surgical treatment should be performed.

Through studying the variations of cerebral blood flow velocity and cerebral extraction rate of oxygen to investigate the effect and mechanism of mild hypothermia therapy on early brain injury (EBI) and cerebral vasospasm (CVS) induced by sever subarachnoid hemorrhage (SAH).

A total of 62 adult patients admitted in the Department of Neurosurgery of Tianjin TEDA Hospital from January 2014 to December 2016 with severe SAH without contraindications of hypothermia therapy were randomly divided into mild hypothermia (MH) group of 30 cases and routine treatment (RT) group of 32 cases.The general data were no significant difference.The routine treatment group got bloody cerebrospinal fluid drainage, spasmolysis, 3H treatment, etc.Besides conventional treatment, MH group got mild hypothermia therapy started on the day of admission within 2-8 hours, lower rectal temperature and maintained at (35±1) ℃, maintain 5-7 d. The mean velocity of middle cerebral artery blood flow (VmMCA) and Lindergaard index of two groups were detected by transcranial Doppler to indirectly evaluate the degree and evolution of CVS.Blood gas analysis was performed to obtain the blood oxygen content of the artery and jugular vein (CaO₂/CjvO₂) in the two groups at the same time, and the cerebral extraction rate of oxygen (CERO₂) = (CaO₂-CjvO₂)/CaO₂ was calculated.

Within 5 times of admission d1, d2, d3, d7 and d14, mean results of VmMCA of RT group were significantly higher than those of the MH group at d2, d3, d7 and d14 on statistics.The changes of CERO₂ between MH group and RT group during the observation period were compared at the same time: there was no significant difference between d1 and d14 (P>0.05); at d2, d3 and d7 showed marked differences, and that of the MH group was significantly lower than that of the RT group′ (P<0.01). The correlation analysis showed that it had a weak correlation between CERO₂ and VmMCA (P>0.05) in the MH group, and CERO₂ was significantly positively correlated with VmMCA in the RT group (P<0.01).

MH therapy has a positive significance to reduce the incidence, degree and the duration of CVS.The relationship between CVS and the degree of hypoxia in brain was broken by the MH therapy to reduce the adverse effects of EBI through reducing metabolism, thereby alleviating hypoxia damage in brain tissue.Setting the appropriate target temperature and the course of treatment and then the gentle rewarming process can reduce the incidence of complications of hypothermia therapy.

By investigating the relationship of pregestational body mass index(BMI), trimester-specific gestational weight gain (rate) during the first, second, third and total trimesters of pregnancy with adverse pregnant outcomes, to evaluate the effects of different pregestational BMI, trimester-specific gestational weight gain on pregnant outcomes, and to provide evidences for gestational weight control.

From April 2015 to January 2016, 964 pregnant women in Zhejiang Taizhou First People′s Hospital and Taizhou Huangyan Maternal & Child Care Service Center were enrolled in random for prospective study and were divided into groups according to the Institute of Medicine 2009 guidelines[IOM2009]. (1)They were divided into four groups according to pregestational BMI: low body mass, normal body mass, over body mass and obese group.(2)They were divided into three groups according to trimester-specific gestational weight gain (rate): normal gestational weight gain, insufficient gestational weight gain and excessive gestational weight gain.(3)The gestational weight gain and pregnant outcomes were recorded by using self-made information table, including the incidence rates of gestational diabetes mellitus (GDM), neonatal birth weight (BW), hypertensive disorders complicating pregnancy (HDCP), cesarean section, pliers delivery, shoulder dystocia, fetal macrosomia, small for gestational age (SGA), premature rupture of membranes, neonatal asphyxia, and neonatal hypoglycemia.

(1)In this study, 964 pregnant women were enrolled, no significant differences were found in terms of age, culture level, pregnancy times and delivery times of the different pregestational BMI groups (P>0.05). (2)The incidences of GDM, HDCP, premature rupture of membranes, cesarean section, pliers delivery, shoulder dystocia, fetal macrosomia, SGA, neonatal asphyxia and neonatal hypoglycemia were as dependent variables and trimester-specific gestational weight gain (rate) was as independent variable.Multivariate Logistic regression analysis showed that the pregnancy obesity was associated with increased risks of GDM and HDCP, theOR values were 6.63 and 2.60 (P<0.05). The excessive gestational weight gain (rate) of the total trimester of pregnancy was associated with increased risks of GDM, fetal macrosomia and cesarean section, theOR values were 2.05, 1.36 and 1.60, (P<0.05). There was no statistical significance in other groups (P>0.05). (3)Compared to the normal groups, the pregnancy obesity and excessive gestational weight gain of the first, second, third and total trimesters of pregnancy were all associated with an increased risk of GDM, theOR values were 7.36, 1.61, 1.81, 2.20 and 2.4 (P<0.05), respectively.The incidences of HDCP, cesarean section and neonatal hypoglycemia in pregnant women with GDM were higher than those in normal pregnant women (P<0.05).

There is a significant correlation among pregestational BMI, gestational weight gain (rate) during the first, second, third and total trimesters of pregnancy with adverse pregnant outcomes, and it suggested that we could reduce the incidence of adverse pregnant outcomes by pre-pregnancy BMI and gestational weight control, and the focus should be placed on pre-pregnancy BMI control.

To investigate the value of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of BI-RADS 4 breast masses.

A total of 72 patients were collected from the First Hospital of Shanxi Medical University from January 2016 to December 2017.79 breast masses were confirmed by biopsy or surgical pathology.All the masses were classified by BI-RADS according to conventional ultrasound and CEUS was performed in parallel.Based on the results of the CEUS predictive model, the benign and malignant features of the breast BI-RADS type 4 tumors were re-determined: (1) conventional ultrasound BI-RADS classification+ CEUS predictive model: both of them were malignant when malignant; (2) re-adjusting BI-RADS classification by CEUS predictive model: if the malignant CEUS predictive model, upgrade a class, if the benign CEUS predictive model, downgrade a class.The diagnostic efficiency of the two methods in breast masses of BI-RADS 4 was compared.

(1) There were 36 malignant masses and 43 benign masses in 79 breast masses.Diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the conventional ultrasound BI-RADS classification, CEUS predictive model, conventional ultrasound BI-RADS classification+ CEUS predictive model and the adjusted BI-RADS classification were 86.1%, 65.1%, 74.7%, 67.4%, 84.8%; 88.9%, 76.7%, 82.3%, 76.2%, 89.2%; 80.6%, 86.0%, 83.5%, 82.9%, 84.1%; 97.2%, 76.7%, 86.1%, 77.8%, 97.1%, respectively.(2) The area under the receiver operating characteristic (ROC) curve of conventional ultrasound BI-RADS classification, CEUS predictive model, conventional ultrasound BI-RADS classification+ CEUS predictive model and the adjusted BI-RADS classification was 0.756, 0.828, 0.833, 0.870, respectively.Before and after the adjustment of BI-RADS classification, the difference was statistically significant (Z=2.322, P<0.05).

The diagnostic efficiency that CEUS predictive model adjusted classification of BI-RADS 4 breast masses is better, the method can reduce unnecessary biopsy.

To explore the risk factors of primary graft dysfunction (PGD) after lung transplantation and provide a new therapeutic strategy for PGD.

A retrospective analysis of lung transplant patients from January 2014 to July 2017 in Henan Provincial People′s Hospital.According to the PGD classification standard established by the International Society for Heart and Lung Transplantation, the association of potential risk factors with PGD was analyzed by using multivariable Logistic regression.

Fourteen of 30 patients (46.7%) developed grade 3 PGD.There was no significantly statistical difference in gender, etiology, duration of anesthesia, amount of blood transfusion, amount of blood transfusion and donor gender(all P>0.05). Body mass index (BMI), donor pulmonary cold ischemia time, duration of operation, extracorporeal membrane lung oxygenator (ECMO), systolic pulmonary arterial pressure and donor smoking history were all higher than those of non-PGD patients (allP<0.05). Independent risk factors for PGD were donor pulmonary cold ischemia time (OR 1.032, 95%CI 1.000-1.065, P=0.048); systolic pulmonary arterial pressure (OR 1.258, 95%CI 0.969-1.632, P=0.007); donor smoking (OR 8.879, 95%CI 1.096-71.913, P=0.041).

Donor pulmonary ischemic time, systolic pulmonary arterial pressure and donor smoking history are PGD risk factors, which provide new ideas for PGD treatment.

To investigate the pathogenesis of young and middle-aged stroke patients with patent foramen ovale (PFO) by analyzing clinical characteristics.

Data of 298 consecutive young and middle-aged patients diagnosed as stroke were retrospectively collected from Department of Neurology, Beijing Anzhen Hospital from January 2010 to January 2017.Patients were divided into cryptogenic stroke (CS) group and not-CS group.Risk factors, characteristics of PFO and infarct of imaging were analyzed between two groups.

PFO was confirmed in 88 patients among 298 young and middle-aged stroke patients.The prevalence of PFO was 29.6%. Forty-six patients were assigned into CS group and 42 patients were assigned into not-CS group.The ratio of atrial fibrillation and internal carotid artery stenosis in CS group was lower than that in not-CS group (0 vs 12, 4 vs 22, P<0.05). The concentration of homocysteine was lower in CS group than that in not-CS group [(10.4±1.1) mmol/L vs(14.6±2.4) mmol/L,P<0.05]. The difference of migraine and scores of scale of Risk of Paradoxical Embolism (RoPE) in CS group were significantly higher than those in not-CS group [18 vs 4, (6.8±2.5)vs (5.5±1.4),P<0.05]. The prevalence of big PFO, constant right-to-left shunt and atrial septal aneurysm (ASA) in CS group was higher than that in not-CS group (26 vs 6, 36 vs 18, 5 vs 0,P<0.05). Post-circulation location, single cortex infarction and multiple infarctions in multiple vascular areas are indicative of PFO (25 vs 18, 15 vs 7, 20 vs 8,P<0.05).

Migraine, high scores of RoPE, big PFO, constant RLS and ASA are indicative of important role of PFO in cryptogenic stroke in young and middle-aged patients.The imaging characteristics of CS with PFO should be emphasized.

Curcumin was used as photosensitizers in photodynamic therapy on cervical cancer xenografts in nude mice.Analysis the expression changes of Notch and downstream gene as NF-κB and VEGF before and after DAPT inhibition of Notch signaling pathway in vivo experiments.Our aim was to investigate the possible mechanism of Notch signaling pathway in the treatment of cervical cancer with PDT.

A cervical cancer model of nude mice was established by subcutaneous inoculation of human cervical cancer Me180 cells 200 μl.After the success of the model, the experimental animals were divided into 4 groups (model group, curcumin PDT group, simple DAPT group, curcumin-PDT+ DAPT group), each group was 12.Tumor volume changes were analyzed and HE staining was observed in each group.MRNA and protein expression of Notch1 and its downstream NF-κB, VEGF were detected by RT-PCR, immunohistochemistry and Western blot before and after inhibition of Notch signaling pathway by DAPT.

Except the control group, the tumor volume of the other three groups remained unchanged or slightly reduced after 1-7 days of treatment.The difference was significant (P<0.05). HE staining showed the most obvious necrosis of curcumin-PDT group with DAPT.Both DAPT and curcumin-PDT could reduce the expression level of Notch1 in mRNA.The inhibition rates were 42.17% and 40.54%, respectively.And the inhibitory effect of curcumin-PDT with DAPT on Notch-1 was the strongest (79.22%) (P<0.01), and two of them had synergistic effect after combination with curcumin-PDT.But the expression of Notch-2 has no obvious inhibitory effect (P>0.05). Both DAPT and curcumin-PDT can inhibit the protein expression of Notch1, NF-κB and VEGF, and two of them have synergistic effect after combined use.

DAPT can effectively block the Notch signaling pathway and inhibit the proliferation of cervical cancer cell line Me180.The application of DAPT to inhibit Notch signaling pathway after photodynamic therapy can achieve synergistic effect, which is mainly related to the down-regulation of the expression of Notch1 and NF-κB.Notch signaling pathway may be one of the targets of curcumin-PDT photodynamic therapy.

A 57-year-old male patient came to our hospital on 19 April 2013 due to gross hematuria for 1 week. Physical examination on admission: clear consciousness and good spirits, no yellowing staining of skin and sclera, no swelling of both lower limbs, heart and lungs (-), liver and spleen under the costs, flat and soft abdomen without tenderness and rebound pain, bilateral percussion pain in the kidney area (-), no abnormality in ureteral pathway, percussion pain in the bladder area (-), NS (-), and improvement in hematuria.

A 37-year-old married male was admitted to the hospital for "numbness of the left lower limb for more than 2 years, numbness of the right lower limb for 16 months, repeated headache with fever for 14 months, and double vision for more than 2 months". The patient developed left toe numbness without obvious trigger in June 2015, and no special treatment was given. The symptoms resolved by the end of 2015. In March 2016, there was no obvious trigger for back pain, which was persistent tingling and severe. The local hospital performed "acupuncture" treatment, and the pain improved, but numbness and weakness of the right lower limb gradually appeared, mainly numbness of the right calf and right foot, which gradually worsened. In April, walking was unstable, consciously stepping on empty feelings, easy to fall, and it was difficult to squat down and stand up; The weakness of lower limbs is aggravated after movement and can be relieved after rest. The local hospital considers "spinal vascular disease is not excluded" and gives treatment such as nutrition of nerves and improvement of circulation (details are unknown), and the symptoms are slightly relieved. In May 2016, the patient developed headache, which was swelling and pain in the right temporal roof, which was tolerable, lasting for about 1 h each time, several times a day to once a few days, and was relieved by self-administration of ibuprofen, sometimes accompanied by nausea and low fever, with a body temperature of 37~37.5 ℃. On June 14, 2016, he went to the Department of Neurology, PLA General Hospital, and underwent lumbar puncture examination. The cerebrospinal fluid white blood cells were 12×10⁶/L, albumin 619.9 mg/L, lumbosacral nerve root magnetic resonance showed cauda equina and lumbosacral nerve plexus changes (Figure 1), consistent with lumbosacral radiculitis, electromyography showed neurogenic damage of both lower limbs, and lung CT showed multiple small nodules in both lungs, which were considered benign. The diagnosis of lumbosacral nerve root damage and non-specific lumbosacral radiculitis was not excluded. Dexamethasone 20 mg, once/d, was given for 15 days. The weakness of the right lower limb was improved, the numbness was significantly reduced, and he was basically able to walk normally. After discharge, he was changed to oral prednisone tablets 60 mg, gradually reduced to stop, and took it for 1 month.

A 56-year-old female patient underwent maxillary mass resection and radical maxillary sinus resection in the Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Jining Medical College in May 2017 due to upper palatal mass for 3 years. The postoperative pathological diagnosis was (maxillary) mesenchymal tumor, and then she was admitted to the Department of Neurology of Jining Medical College in July 2017 due to headache and right eyelid ptosis for 10 days. The headache was mainly on the right half of the head, which was paroxysmal and severe, without nausea, vomiting, limb twitching and unconsciousness. Physical examination: symptoms of right oculomotor nerve paralysis, local defect of left maxilla, normal muscle strength and muscle tone of limbs, bilateral Pap sign not drawn out, no abnormalities in sensory examination, stable and accurate fingers and noses of both fingers. Admitted brain MRI plain scan plus enhancement showed: right parasellar space-occupying lesion, considering the possibility of meningioma, atypical dura cavernous hemangioma to be discharged (Figure 1)； Whole brain angiography showed no obvious vascular abnormalities, so he was transferred to the neurosurgery department and underwent "right parasellar space-occupying microresection with right infratemporal keyhole approach" under combined intravenous and inhalation anesthesia. During the operation, the dura mater bulge of the lateral wall of the cavernous sinus at the floor of the middle cranial fossa was seen, and the texture was tough at touch. The lateral wall of the cavernous sinus was incised, and the tumor was found to be tough in texture and abundant in blood supply, about 2 cm ×3 cm ×3 cm. Postoperative pathology confirmed a (intra-cavernous sinus) mesenchymal tumor, considered sclerosing epithelioid fibrosarcoma (SEF,Figure 2)。

Rheumatic immune diseases are mostly systemic autoimmune diseases, which can lead to severe joint deformities, pain and dysfunction when involving the hip/knee joint, and often require total hip or total knee arthroplasty (THA/TKA). THA/TKA success focuses on optimizing perioperative management^[1]To improve the surgical effect and safety, reduce the surgical risk and increase patient satisfaction, so as to achieve the goal of rapid recovery. Rheumatic immune diseases mostly require long-term use of immunosuppressants, and the risks of perioperative infection, dislocation, rehospitalization rate and recurrence of disease activities are higher^[2,3,4]； At present, the concept of "long-term management and standard treatment" of diseases has gradually penetrated into the diagnosis and treatment of various rheumatic immune diseases. The perioperative management of anti-rheumatic drugs is a thorny problem faced by orthopedic surgeons in clinical activities. The American Rheumatology Association (ACR) and the American Association of Hip/Knee Physicians (AAHKS) jointly issued the "Guidelines for the Management of Perioperative Antirheumatic Drugs for Elective Total Hip/Knee Arthroplasty in Patients with Rheumatic Diseases" at the end of June 2017^[5](hereinafter referred to as the Guide). Now, the contents of the Guidelines on the perioperative management of antirheumatic drugs are briefly summarized and summarized as a reference for clinical practice.

Adenylate-activated protein kinase (AMPK) is a serine/threonine protein kinase widely existing in eukaryotic organisms. Its molecular structure is a heterotrimeric protein composed of three subunits: α, β and γ. The α subunit is composed of two subunits: α 1 and α 2, the β subunit is composed of two subunits: β 1 and β 2, and the γ subunit is composed of three subunits: γ 1, γ 2 and γ 3. The α subunit is its catalytic isomer. The β and γ subunits play an important role in maintaining the stability and the specificity of the substrate. In eukaryotic cells, AMPK plays an important role in regulating cellular energy balance, and its activation is mainly regulated by intracellular AMP/ATP. Any factors that lead to the increase of AMP/ATP, such as increased metabolites, oxidative stress, ischemia and hypoxia, can cause the activation of AMPK. In mammals, calcium/calmodulin-dependent protein kinase kinase (CaMKKb) and liver kinase B1 (LKB1) are two upstream kinases of AMPK. In addition, 5-aminoimidazole-4-carboxamide ribonucleotide (AICAR) is currently recognized as an AMPK activator. AICAR can be taken up by cells and form monophosphate derivatives (ZMP) under the phosphorylation of adenosine kinase. ZMP has an AMP-like effect and can activate AMPK, and positively regulate signaling pathways that supplement ATP supply to cells, such as fatty acid oxidation, glucose transport, glycolysis and autophagy, and negatively regulate biosynthetic processes that consume ATP, including gluconeogenesis, lipid and protein synthesis. In addition, it can also regulate metabolism transcriptionally by directly phosphorylating a series of enzymes in these processes, or phosphorylating transcription factors, co-activators and co-inhibitors. AMPK can also act as an important regulator of aging by interacting with rapamycin target proteins (mTOR) and deacetylases (sirtuins) in many species^[1]。

In the past 20 years, with the development of molecular biology and the progress of gene sequencing technology, lung cancer treatment has developed from the traditional treatment model based on clinical features and pathological typing to the precise treatment model based on genotyping. However, the in-depth exploration of the mechanism of human immunity and the interaction between tumor and human immunity makes immunotherapy obtain good results in many tumor species. The treatment of advanced lung cancer is no longer the traditional single chemotherapy, but has entered the era of precision treatment with chemotherapy, targeted therapy and immunotherapy, as well as the combination of multiple methods. Previous studies on biomarkers to predict the efficacy of chemotherapy have failed to achieve the purpose of predicting or screening people suitable for a certain chemotherapy drug population, and the emergence of new detection methods such as second-generation sequencing (NGS) technology has pointed out the accurate selection of targeted therapy and immunotherapy direction.

Depression is one of the common mental illnesses, and somatic illnesses are often accompanied by depressive symptoms. The characteristics of depression such as high suicide rate, high self-harm rate and high recurrence rate show that depression is a serious social health problem. According to the World Health Organization report, as of 2012, there are estimated to be more than 350 million people with depression worldwide. Year 2014NatureThe epidemiological data released on China shows that the prevalence of depression in China is 3.02%^[1]。 Today's fast-paced, high-stress lifestyle makes depression a high-incidence disease with an increasing incidence year by year. The core clinical symptoms of depression mainly include: (1) "three lows"-low mood, slow thinking and decreased voluntary activity; (2) Psychological symptoms: "three noes"-helplessness, hopelessness and uselessness; (3) "Three Selves"-inferiority, suicide and self-crime; (4) Physical symptoms: sleep disorders, fatigue, weight loss, decreased appetite, decreased sexual desire, constipation, pain, and discomfort. The complaint involves autonomic dysfunction; (5) Other symptoms: depersonalization, disintegration of reality, obsessive-compulsive symptoms^[2]。 Failure to intervene in time will lead to the aggravation of the disease and enter a vicious circle, resulting in high suicide rate and high self-harm rate, bringing heavy burden and serious losses to patients, families and society.

Cervical cancer is the fourth most common malignant tumor in women worldwide, with 85% occurring in developing countries. It is the second leading cause of cancer death among women in developing countries after breast cancer^[1]。 It is estimated that there were 528,000 new cases of cervical cancer and 266,000 deaths worldwide in 2012^[2]。 The incidence of cervical cancer in China is also rising, with 98,900 new cases and 30,500 deaths in 2015^[3]。 According to the guidelines of the National Comprehensive Cancer Network (NCCN), radical cervical cancer surgery (also known as extensive total hysterectomy, RH) and systemic lymphectomy are standard protocols for the treatment of early cervical cancer^[4]。 Different types of RH need to remove a certain range of parauterine tissue to achieve thoroughness of tumor resection. A large number of pelvic nerves are distributed in the parauterine tissues, and RH operation is bound to destroy these nerve tissues, resulting in postoperative bladder, rectal and sexual dysfunction, among which bladder dysfunction is the most common. The incidences of dysuria, stress incontinence, urgency incontinence, frequency and urgency after RH were 36%-47%, 20%-76%, 8%-45%, 23% and 19%, respectively^[5]。 The associated urinary symptoms are the most common complications of surgical treatment of cervical cancer and severely disrupt the quality of life of cancer survivors. Pelvic nerve-preserving radical cervical cancer surgery (NSRH) has become one of the standard procedures for cervical cancer treatment by preserving the autonomic nerves that innervate the bladder to reduce the incidence of bladder dysfunction in patients. In different reports, the proportions of urinary dysfunction after NSRH and RH were 5.4% ~33.3% and 11.3% ~100%, respectively^[6,7,8,9]。 This article discusses and summarizes the neuroanatomy, surgical safety and surgical techniques related to NSRH, and the effects of surgery on organ function, quality of life and survival outcome of patients.